Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), University of Vigo, Vigo, Spain.
Estructura de Gestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain.
Eur Heart J. 2018 Dec 14;39(47):4159-4171. doi: 10.1093/eurheartj/ehy475.
Sleep-time blood pressure (BP) is a stronger risk factor for cardiovascular disease (CVD) events than awake and 24 h BP means, but the potential role of asleep BP as therapeutic target for diminishing CVD risk is uncertain. We investigated whether CVD risk reduction is most associated with progressive decrease of either office or ambulatory awake or asleep BP mean.
We prospectively evaluated 18 078 individuals with baseline ambulatory BP ranging from normotension to hypertension. At inclusion and at scheduled visits (mainly annually) during follow-up, ambulatory BP was measured for 48 consecutive hours. During the 5.1-year median follow-up, 2311 individuals had events, including 1209 experiencing the primary outcome (composite of CVD death, myocardial infarction, coronary revascularization, heart failure, and stroke). The asleep systolic blood pressure (SBP) mean was the most significant BP-derived risk factor for the primary outcome [hazard ratio 1.29 (95% CI) 1.22-1.35 per SD elevation, P < 0.001], regardless of office [1.03 (0.97-1.09), P = 0.32], and awake SBP [1.02 (0.94-1.10), P = 0.68]. Most important, the progressive attenuation of asleep SBP was the most significant marker of event-free survival [0.75 (95% CI 0.69-0.82) per SD decrease, P < 0.001], regardless of changes in office [1.07 (0.97-1.17), P = 0.18], or awake SBP mean [0.96 (0.85-1.08), P = 0.47] during follow-up.
Asleep SBP is the most significant BP-derived risk factor for CVD events. Furthermore, treatment-induced decrease of asleep, but not awake SBP, a novel hypertension therapeutic target requiring periodic patient evaluation by ambulatory monitoring, is associated with significantly lower risk for CVD morbidity and mortality.
睡眠时血压（BP）是心血管疾病（CVD）事件的更强风险因素，比清醒和 24 小时 BP 更有意义，但作为降低 CVD 风险的治疗靶点，睡眠时 BP 的潜在作用尚不确定。我们研究了 CVD 风险降低是否与办公室或动态清醒或睡眠时 BP 平均值的渐进性降低最相关。
我们前瞻性评估了基线动态血压从正常血压到高血压的 18078 名个体。在纳入和随访期间的预定就诊（主要每年）时，连续 48 小时测量动态血压。在 5.1 年的中位随访期间，2311 名个体发生了事件，包括 1209 名经历了主要结局（CVD 死亡、心肌梗死、冠状动脉血运重建、心力衰竭和中风的复合结局）。睡眠收缩压（SBP）平均值是主要结局的最显著血压相关风险因素[风险比 1.29（95%CI 1.22-1.35，每 SD 升高），P<0.001]，无论办公室[1.03（0.97-1.09），P=0.32]还是清醒 SBP[1.02（0.94-1.10），P=0.68]。最重要的是，睡眠 SBP 的逐渐减弱是无事件生存的最显著标志物[每 SD 降低 0.75（95%CI 0.69-0.82），P<0.001]，无论在随访期间办公室[1.07（0.97-1.17），P=0.18]或清醒 SBP 平均值[0.96（0.85-1.08），P=0.47]的变化如何。
睡眠 SBP 是 CVD 事件的最显著血压相关风险因素。此外，治疗诱导的睡眠 SBP 降低，而不是清醒 SBP 降低，这是一个新的高血压治疗靶点，需要通过动态监测定期评估患者，与 CVD 发病率和死亡率的显著降低相关。
